帕金森氏症患者行走跨越障礙物之多目標最佳控制策略

Multi-Objective Optimal Control Strategies of the Locomotor System During Obstacle-Crossing in Patients with Parkinson's Disease

郭祐伸(Yu-Shen Kuo)

指導教授 ： 呂東武

國立臺灣大學/工學院/醫學工程學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10286

摘要

動作的改變帕金森氏症最主要的臨床特徵，過去的研究也指出帕金森氏症患者在執行日常動作例如走路、跨越障礙物較為困難。跨越失敗將導致跌倒與受傷[1-3]。
帕金森氏症患者跨越障礙物的動作分析研究，著重其運動系統參數的表現，如關節角度、關節力矩、關節間協調性、身體質量中心與壓力中心傾斜角的差異性[36]，隨障礙物高度的不同，有些參數改變，有些參數不變，運動參數確實可對關節表現討論，但無法討論整體動作控制策略。Lu(2012)提出的多目標最佳控制方法，定義跨越障礙物之目標函數可由最小能量消耗與最大足部間隙妥協組合而成，並可描述跨越障礙物之控制策略[4]。
本研究目的為使用多目標最佳控制方法，探討帕金森氏症跨越不同高度障礙物之動作控制策略，並探討後腳跨越障礙物與前腳跨越障礙物之策略差異。受試者分為三組：15位正常中老年人(Normal)，15位帕金森氏症第一期患者(PD-I)，15位帕金森氏症第二至三期患者(PD-II&III)，每位受試者被要求跨越三種不同高度之障礙物。本研究結果指出，跨越障礙物之控制策略並無高度間差異，有明顯的組間差異，其中PD-I表現與Normal接近，與PD-II&III服藥前有顯著差異，PD-II&III服藥前(Off)有較保守的跨越障礙物策略；PD-I健側(Non-Dominant)與患側(Dominant)跨越障礙物之控制策略無顯著差異；PD-II&III用藥後(On)控制策略較接近PD-I & PD-II&III；前後腳控制策略只有Normal有顯著差異，Normal後腳跨越的控制策略趨於保守，PD-I & PD-II&III前後腳控制策略並無顯著差異，表示視覺回饋在帕金森氏症患者的控制策略沒有影響。本研究結果提供帕金森氏症患者與前後腳跨越障礙物一個簡單、明確並足以描述跨越障礙物神經控制系統的指標，未來可用於帕金森氏症分級與用藥效果評估之參考。

關鍵字

動作分析 ； 帕金森氏症 ； 運動控制策略 ； 跨越障礙物

並列摘要

Movement change is the essential symptom of Parkinson’s disease (PD). Obstacle crossing and walking with a simple cognitive task increase the task demands for the patients with PD. Failure to cross the obstacle will result in falls and injuries[1-3].
Kinematic and kinetic data, such as joint angle, joint moment, inter-joint coordination and COM-COP inclination angle, is used in motion analysis of patients with PD during obstacle crossing[36]. Although these data are useful for evaluating the functional performance of patients with PD, there still exist difficulties in the synthesis of the information to uncover the overall control strategies. Lu(2012) suggested that obstacle-crossing was formulated as an optimal control problem with two conflicting objectives: minimization of mechanical energy expenditure and maximization of foot-obstacle clearance[4].
The purposes of the present study were to identify the control strategy of patients with PD obstacle-crossing of different heights with a multi-objective optimal control (MOOC) technique. 15 mid-old subjects, 15 1st stage of patients(PD-I), 15 2nd-3rd stage of patients(PD-II&III) were asked to walked and crossed obstacles of three different heights while their kinematic and ground reaction force data were measured simultaneously.
Differences of control strategies of obstacle crossing were not found in height effects, but found in group effects. The strategies of PD-I are similar to Normal group, but different with PD-II&III. PD-II&III before treatment (Off) is shown an conservative control strategies; There were no significant differences of control strategies between non-dominant limb and dominant limb during obstacle crossing; Strategies of PD-II&III after treatment (On) is similar to PD-I & PD-II&III; Differences of control strategies in leading and trailing limbs were only found in Normal group, control strategies of Normal trailing limb is more conservative, this mean the visual feedback is not effect in patients with PD. The present study is useful for studying obstacle-crossing form a system level perspective in patient with PD. The results will help in classification of PD and estimation of medical treatment.

並列關鍵字

Parkinson’s disease ； motion analysis ； motor control strategy ； obstacle-crossing

參考文獻

1. Sattin, R.W., Falls among older persons: a public health perspective. Annu Rev Public Health, 1992. 13: p. 489-508.

2. Tinetti, M.E. and M. Speechley, Prevention of falls among the elderly. N Engl J Med, 1989. 320(16): p. 1055-9.

3. Tinetti, M.E., M. Speechley, and S.F. Ginter, Risk factors for falls among elderly persons living in the community. N Engl J Med, 1988. 319(26): p. 1701-7.

4. Lu, T.-W., S.-C. Chen, and H.-C. Chiu, Best-compromise between mechanical energy expenditure and foot clearance predicts leading limb motion during obstacle-crossing. Gait & Posture, 2012. 36(3): p. 552-556.

5. Obeso, J.A., et al., The basal ganglia and disorders of movement: pathophysiological mechanisms. News in physiological sciences : an international journal of physiology produced jointly by the International Union of Physiological Sciences and the American Physiological Society, 2002. 17: p. 51-55.